This small conference grant proposal addresses one of the most significant translational research problems of our time: in spite of rapid advances in evidence-based medicine, we know very little about how well or under what conditions healthcare innovations are sustained once they are put into practice. Building on recommendations from a 2010 AHRQ-supported conference on scale up and spread, we propose a working meeting to coalesce public policy leaders, donors, practitioners, and researchers around the topic of "sustaining the gains". We will present real-world examples of sustainability successes and failures, prevailing conceptual and methodological approaches, and empirical findings regarding the sustainability of evidence-based healthcare. This small conference grant application pursues three aims: 1. To capture the state of the field by identifying key conceptual and methodological work on the sustainability of evidence-based healthcare;2. To convene an intensive working meeting of thought leaders and stakeholders with a shared investment in the sustainability of effective healthcare practices;and 3. To produce and disseminate a detailed agenda for studying sustainability, including recommendations for research and policy and practice action plans to build the evidence-base for sustaining effective healthcare innovations. These products can be used to inform and help shape empirical study of sustainability around a variety of health care interventions. This work will also inform future policy, practice, training of health services researchers, and formation of collaborative relationships between researchers and communities. Specific conference outcomes include a clear picture of existing evidence about how often and under what conditions evidence-based healthcare is sustained in usual care, following its implementation or experimental trial;a critical assessment of prevailing research methods used to study sustainability;and a set of specific recommendations for a research agenda to help build an empirical base around four key methodological challenges in sustainability research. Conference products will be disseminated through the NIH conference on the science of dissemination and implementation, through implementation science training networks, to federal program staff of funding agencies and CMS, and through networks of key health and public health policy and practice leaders. PUBLIC HEALTH RELEVANCE: Project Narrative Billions of U.S. tax dollars are spent each year on research and hundreds of billions are spent on service delivery programs, but we know very little about how to sustain healthcare innovations once they are implemented. This conference will produce an agenda for empirical study of sustainability, which in turn will lead to a solid understanding of how to sustain high quality healthcare.